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    "textoCompleto" => "<p class="elsevierStylePara">Rhabdomyolysis is a disorder caused when damaged muscle releases toxic substances such as creatine kinase &#40;CK&#41; and myoglobin into the bloodstream&#46; The main associated risk factors are alcoholism&#44; lesions caused by compression&#44; overexertion&#44; heat intolerance&#44; sunstroke&#44; low phosphate levels&#44; convulsions and drug use or overdose&#46; Drugs commonly involved are cocaine&#44; amphetamines&#44; statins and heroin&#46;</p><p class="elsevierStylePara">We present the case of a male patient aged 41 years who was transported to the emergency department due to reduced consciousness after falling at home&#46; His medical history included hepatitis C&#44; paranoid schizophrenia and habitual use of heroin&#46; In the 72 hours prior to admission&#44; he began to experience muscle weakness and widespread myalgia&#44; which coincided with starting a methadone rehabilitation programme&#46; In the 24 hours before admission&#44; he also experienced headache&#44; nausea&#44; vomiting and a fever of 39&#46;5&#186;C&#46;</p><p class="elsevierStylePara">Physical examination showed drowsiness&#44; lack of awareness of surroundings&#44; hypotension &#40;70&#47;30mm Hg&#41;&#44; 72&#37; baseline oxygen saturation and signs of mucocutaneous dehydration&#46; The examination revealed no other significant abnormalities&#46; The blood count and biochemical test results were as follows&#58; pH 7&#46;10&#59; PCO<span class="elsevierStyleInf">2</span> 23mm Hg&#59; HCO<span class="elsevierStyleInf">3</span> 16mEq&#47;l&#59; haemoglobin 15&#46;5mg&#47;dl&#59; leukocytes 23&#215;10<span class="elsevierStyleSup">3</span>&#47;uL &#40;88&#37; neutrophils&#41;&#59; C-reactive protein &#40;CRP&#41; 10mg&#47;dl&#59; creatinine 2&#46;88mg&#47;dl&#59; potassium 6&#46;6mEq&#47;l&#59; alanine aminotransferase 160IU&#47;l&#59; aspartate aminotransferase 523IU&#47;l&#59; phosphorus 7&#46;0mg&#47;dl&#59; CPK 86&#160;000IU&#47;l&#46; Neurological disorders were ruled out by a cranial CT and lumbar puncture&#46; In subsequent hours&#44; renal function deteriorated until serum creatinine reached 11&#46;4mg&#47;dl&#46; Volume replacement therapy was initiated&#44; which resulted in significant positive balances and urine production&#59; renal function improved continuously over the following days&#46; Haemodialysis was not required&#46; Upon discharge&#44; the patient&#8217;s creatinine level was 2&#46;1mg&#47;dl&#44; but he was lost to follow-up&#46;</p><p class="elsevierStylePara">Acute renal failure is the most severe complication of rhabdomyolysis&#44; whose prognosis depends on the degree to which renal function is compromised&#46; It often presents with high CPK levels&#44; hypercalcaemia&#44; hyperphosphataemia and high anion gap metabolic acidosis&#46; Our patient experienced all of these disorders&#46; &#8220;Hard&#8221; drugs such as heroin and cocaine are classically associated with rhabdomyolysis&#46; It is widely demonstrated that narcotics lead to rhabdomyolysis&#44; which causes acute renal failure due to tubular obstruction arising when myoglobin leaks into the kidney&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Mechanisms associated with the development of rhabdomyolysis in cases of drug abuse are decreased level of consciousness&#44; coma or prolonged immobilisation being the main cause&#46; Prolonged compression of muscles leads to ischaemia&#44; which in turn triggers rhabdomyolysis&#46; On the other hand&#44; the direct manner in which methadone leads to rhabdomyolysis seems to arise from an increase in the muscle&#39;s demand for oxygen&#44; which augments the state of muscle ischaemia&#46;<span class="elsevierStyleSup">1&#44;2</span></p><p class="elsevierStylePara">Most of the cases described are associated with abuse of multiple substances&#44; such as heroin&#44; cocaine&#44; benzodiazepines or alcohol&#46;<span class="elsevierStyleSup">3&#44;4</span> However&#44; our case is an interesting one&#44; since few articles describe rhabdomyolysis and acute renal failure caused by methadone abuse&#46;<span class="elsevierStyleSup">1&#44;5</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p>"
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